First reported United States case of Legionella pneumophila serogroup 1 pneumonia in a patient receiving anti-tumor necrosis factor-alpha therapy

Hawaii Med J. 2009 Jun;68(5):109-12.

Abstract

Legionellosis has been reported to be an extremely rare disease in Hawai'i. The authors report a case of a 67-year-old woman with a history of rheumatoid arthritis treated with long-term adalimumab who developed severe right-sided community-acquired pneumonia and a parapneumonic effusion. Legionella pneumophila serogroup 1 was confirmed as the microbiologic cause based on a positive urine Legionella antigen as well as direct fluorescent antibody and Legionella culture of bronchoalveolar lavage. This is the first reported case of Legionella pneumonia associated with anti-tumor necrosis factor (TNF)-alpha therapy in the United States. There have been several reports of an increased association between legionellosis and treatment with a TNF-alpha antagonist. With the increasing use of TNF-alpha antagonists, Legionella pneumophila should be recognized as a potential re-emerging pathogen. Clinicians should particularly consider the diagnosis of legionellosis in patients who are immunocompromised, including those who receive anti-TNF-alpha therapy, or who have severe pneumonia. In such cases, there should be a low threshold for including empiric Legionella antimicrobial coverage until the diagnosis can be confirmed or reasonably excluded.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adalimumab
  • Aged
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents / adverse effects
  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / immunology
  • Asian People
  • Female
  • Hawaii
  • Humans
  • Immunocompromised Host*
  • Legionella pneumophila / classification
  • Legionella pneumophila / isolation & purification*
  • Legionnaires' Disease / immunology
  • Legionnaires' Disease / microbiology*
  • Serotyping
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents
  • Tumor Necrosis Factor-alpha
  • Adalimumab